Aravot D J, Barak J, Vidne B A
J Cardiovasc Surg (Torino). 1986 Sep-Oct;27(5):613-7.
Massive unexplained bleeding is a catastrophic complication of open heart surgery. The following paper describes a successful attempt to terminate such a hemorrhage by induction of controlled cardiac tamponade which caused augmentation of mediastinal pressure without hemodynamic decompensation, thereby aiding in hemostasis. This modality has not previously reported. Few events in clinical medicine are so ominous as the major unexplained hemorrhage. Diffuse bleeding from multiple transected small vessels may be controlled by mechanical techniques which apply pressure directly over the bleeding area. However, where the mediastinum is the source of bleeding, application of such a direct pressure with a closed chest, is both technically difficult and potentially risky. Reported attempts to stop bleeding by increasing the mediastinal pressure included the induction of pneumothorax, and the increase of positive end expiratory pressure (PEEP) has been published. To the best of our knowledge, a deliberate induction of controlled cardiac tamponade in order to terminate prolonged unexplained massive postcardiotomy hemorrhage has not been reported so far.
大量不明原因出血是心脏直视手术的灾难性并发症。以下论文描述了一次成功尝试，即通过诱导控制性心脏压塞来终止此类出血，该方法在不导致血流动力学失代偿的情况下增加纵隔压力，从而有助于止血。此前尚未报道过这种方法。临床医学中很少有事件像不明原因的大出血那样凶险。来自多个横断小血管的弥漫性出血可通过直接对出血区域施加压力的机械技术来控制。然而，当纵隔是出血源时，在闭合胸腔的情况下施加这种直接压力在技术上既困难又有潜在风险。已报道的通过增加纵隔压力来止血的尝试包括诱导气胸，以及增加呼气末正压（PEEP）。据我们所知，迄今为止尚未报道过为终止心脏术后长时间不明原因的大量出血而故意诱导控制性心脏压塞的情况。
